Background: Targeted cancer therapy is a new approach for the treatment of cancer. It involves a specific molecular target, mainly a receptor that serves as a target for monoclonal antibodies or tyrosine kinase inhibitors. Side-effects of these new regimens are described to be mild, compared to those of classical chemotherapy. There is a lack in the documentation and understanding of oral complications related to molecularly targeted drugs.Methods: In this review, we tried to make a systematic review of the databases Pubmed and Scopus, using "targeted cancer therapy" and "oral", or "mucositis", or "stomatitis", or "bleeding", or "hemorrhage" as search terms. Specific drug name searches were not conducted. The search yielded 97 results. Only articles related to EGFR and VEGFR inhibition were selected. Finally 13 articles met the criteria. Results are discussed and possible pathogenetic mechanisms for the complications of targeted cancer therapy regimens are presented.Results: It appears that the most serious side-effect is mucositis/stomatitis that may affect the whole gastrointestinal tract. It rarely results in treatment discontinuation. Reduced saliva secretion, xerostomia and dysphagia can be severe with some regimens and interfere with food uptake. Osteonecrosis, wound healing impairment, spontaneous gingival bleeding and dysgeusia were also reported.Conclusions: Considering these data it is obvious that symptoms related to cancer treatment should be considered in the context of the holistic management of patients. Oral complications should not be ignored but recorded during physical examination, because they may significantly impair daily activities and patients' quality of life.

Eosinophilic esophagitis (EoE) is a clinical entity with continuously increasing incidence in children and adults. Diet therapy and corticosteroids are the most important therapeutic interventions currently used, while new therapies are being developed, based on the research of the disease mechanisms. In this review we assess the results of the latest clinical trials on management of patients with EoE, and the advances in the development of novel drug therapies.

Although the prevalence of a mental disorder, in general, in patients with diabetes mellitus is regarded to be comparable to the general population, an increased prevalence of depressive disorders, often comorbid with anxiety, has been reported in patients with diabetes mellitus. The co-occurrence of depression in diabetes is attributed to a variety of factors, including the psychological and psychosocial impact of the disease, a potential common genetic susceptibility and common pathophysiological abnormalities involving neuroimmunological and neuroendocrinical pathways, as well as microvascular brain lesions due to diabetes mellitus. However, issues concerning pathogenesis and causality of this high co-occurrence are not fully determined yet. Still, the presence of depression in patients with diabetes mellitus is of vast importance, as it is usually associated with poor disease control, adverse health outcomes and quality of life impairment. This article aims to provide a comprehensive review of epidemiological findings, clinical considerations and management strategies concerning depression in patients with diabetes mellitus.

Oral Mucositis is a common complication of cancer therapy which may limit the completion of treatment and affect the quality of life of the patient. As we have come to understand its pathogenesis new developments in its management and prevention have allowed us minimize this side effect.

Background and Aim: Elevated serum tumor necrosis factor-á (TNF-á) concentra tion and a polymorphism of the TNF-á gene at the position -308 in the promoter re gion are associated with obstructive sleep apnea-hypopnea syndrome (OSAHS). We aimed to determine the association of this polymorphism with OSAHS in Greek patients.Patients and Methods: A blood sample was obtained from 220 patients clinicaly di agnosed with OSAHS and 319 normal controls. TNF- genotype was determined from nucleus containing cells from whole blood using a PCR method.Results: The results demonstrated that the distribution of alleles was significantly dif ferent when comparing the OSAHS patients group to the healthy controls. The ap pearance of AA (p=0.04) and AG (p<0.001) genotypes was significantly greater in OSAHS patients (8.6% and 32.7%, respectively) compared to the healthy control group (4.4% and 26.3%, respectively). Correspondingly, the appearance of the GG genotype was significantly lower in OSAHS patients compared to healthy controls (53.6% vs 69.3%). The A and G allele appeared at a frequency of 27.5% and 72.5% respectively in the OSAHS groups, and 17.6% and 82.4% in the control group re spectively. Conclusions: The distribution of genotypes and alleles of the single nucleotide poly morphism of TNF- (-308) of OSAHS patients varies from healthy controls.

Background and Aim: Benign epilepsy with centro-temporal spikes (BECTS) is one of the most frequent epileptic syndromes in children. It is placed among the idiopathic localization-related epilepsies. However, the relationship between unilateral or bilateral localization of interictal stereotyped focal spikes on electroencephalogram (EEG) and the effectiveness of anti-epileptic drugs has not been studied yet.Patients and Methods: We studied 55 neurodevelopmentally normal children who had been diagnosed with BECTS. Children were subdivided into two groups, based on EEG findings: Group A comprised 30 children with unilateral findings on EEG and Group B 25 children with bilateral findings on EEG. All patients in the present study were started on an anti-epileptic medication after the third seizure (Sodium Valproate, Carbamazepine, Oxcarbazepine) and we studied the response to medications.Results: Children with bilateral findings on EEG had the same response to treatment with either Sodium Valproate or Carbamazepine or Oxcarbazepine. Other side, children with unilateral findings on EEG corresponded best to Carbamazepine or Oxcarbazepine.Conclusions: Children diagnosed with BECTS and bilateral discharges on EEG have good response to treatment with either Sodium Valproate or Carbamazepine or Oxcarbazepine.

Background: The Scoliosis Research Society-22r Questionnaire (SRS-22r) is a questionnaire assessing the health related quality of life of patients with scoliosis. Aim of this study was to evaluate the validity and reliability of the Greek Version of the SRS-22r in patients suffering from scoliosis who were treated conservatively.Methods: The (translated and adapted) Greek versions of the SRS-22r together with the previously validated Short Form-36 questionnaire were mailed to 117 patients suffering from idiopathic scoliosis. Two weeks later, the Greek SRS-22r was mailed to the same patients once again. The internal consistency, reproducibility and concurrent validity were assessed.Results: Factor analysis revealed a five-factor structure. The study demonstrated high Cronbach á coefficients for all but the "Satisfaction with management" domain, when compared with the original questionnaire. Intraclass correlation was excellent regarding every domain of the SRS-22r. Concerning concurrent validity, one domain had excellent (r=0.75-1), thirteen domains good (r=0.50-0.75) and 16 domains moderate correlations (r=0.25-0.50) when compared with the relevant domains of the SF-36 questionnaire.Conclusions: This Greek Version of the SRS-22r outcome instrument is a validated questionnaire which can be used to evaluate Greek-speaking patients suffering from Idiopathic Scoliosis who are being treated conservatively.

Background: Placental supply of fatty acids (FA) is essential for normal foetal development but in premature infants this supply is interrupted. To investigate the association of intrautrine growth restriction with serum phospholipid and breast milk FA composition, we compared preterm infants small for gestational age (SGA) and matched appropriate for gestational age (AGA), and their mothers' milk during the first 4 weeks of postnatal life.Methods: Sera from 11 SGA and 12 AGA infants born 34-36 weeks of gestation were collected at birth, 14th and 28th day, and breast milk on 14th and 28th day after birth. FA composition was analyzed by gas chromatography.Results: Preterm SGA infants had significantly lower oleic, total monounsaturated FA (MUFA), docosahexaenoic acid (DHA) and n-3 polyunsaturated FA (PUFA) and higher levels of stearic and linoleic acid at birth than AGA infants (p<0.05). DHA was significantly lower, whereas docosatetraenoic and docosapentaenoic acids were higher in SGA infants after 28 days. Mothers of AGA infants had markedly lower levels of MUFA and higher levels of total and n-6 PUFA in their breast milk.Conclusion: SGA infants have altered serum phospholipid FA composition at birth and during their first month of life, probably due to inadequate transplacental supply and activity of desaturase system. Results on human milk suggest that pregnancies with AGA or SGA would later influence breast milk FA composition.

Background: The omega 3 fatty acids play an important role in many physiological processes. Their effect is well documented in neurodegenerative diseases and inflammatory diseases. Also, aging as a biophysiological process could be influenced by eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) components of fish oil. However there are not many studies showing the effect of PUFA (polyunsaturated FA) suplementation in eldery brain functions and the response to oxidative strees. The aim of this study was to investigate the effects of dietary omega-3 fatty acid supplementation on levels of lipid peroxidation and oxidant/antioxidant status of brain tissue in aged (24 months old) Wistar rats.Methods: Animals were divided in two groups. Control group (n=8) was fed with standard laboratory food and received water ad libitum. Treated group (n=8) was also fed with standard laboratory food, water ad libitum and received fish oil capsules (EPA+DHA) for 6 weeks. Daily dose was 30mg EPA and 45mg DHA (capsules: 200mg EPA and 300mg DHA; inhouse method). At the end of treatment animals were sacrificed and brains were collected and frozen on -80oC. The levels of lipid peroxidation (malondialdehyde - MDA), activity of catalase (CAT) and activity of superoxide dismutase (SOD) were examined in cerebral cortex. Catalase activity was determined by measuring the decrease in absorbance (H2O2 degradation) at 240 nm for 3 min and expressed as U/mg protein. Total SOD (superoxide dismutase) activity was performed at room temperature according to the method of Misra and Fridovich. The extent of lipid peroxidation (LPO) was estimated as the concentration of thiobarbituric acid reactive product malondialdehyde (MDA) by using the method of Aruoma et al. The incorporation of fatty acids in cellular membranes was confirmed by gas chromatography.Results: Our results showed that lipid peroxidation significantly decreased in treated animal group, where MDA concentration was 0.38±0.001 vs. 0.43±0.001 nM/ml (p<0.05) in control. However SOD activity increased significantly in treated animal group 1.57±0.24 vs. 4.12±0.15 U/gHb/L (p<0.01) in control. CAT activity decreased in treated group but not significantly.Conclusion: Incorporation of omega-3 fatty acids after their supplementation had beneficial effects on brain tissue. Omega-3 fatty acids increased activity of SOD and decreased lipid peroxidation. Changes in oxidative/antioxidative balance are a result of EPA and DHA effects on lipids and enzymes of antioxidative system.

Background: Congenital anomalies of the coronary arteries are rarely encountered in patients undergoing cardiac catheterization. In patients undergoing coronary angioplasty or cardiac surgery, angiographic recognition of coronary anomalies is important for the proper management of these patients.Method: We retrospectively reviewed the records of 12,844 patients who had previously undergone coronary angiography in the catheterization laboratory of Trakya University Cardiology Department over the past 14 years. We tried to investigate the presence of a variety of coronary anomalies in these patients to determine the prevalence of various types of anomalies and their anatomic variation in a selected population of the European part of Turkey. The potential association between coronary atherosclerosis and congenital coronary anomalies was also investigated.Results: Among these patients, 95 patients were found to have major coronary anomalies that predominantly comprised anomalous aortic origin of coronary arteries. Among the major anomalies, anomalous aortic origin of the left circumflex (LCX) artery from the right sinus of Valsalva or right coronary artery (RCA) was found to be the the most prevalent (46 out of 95 patients) outnumbering the second most common anomaly that was anomalous aortic origin of the RCA (32 out of 95 patients). In the present study, the incidence of major coronary arterial anomaly was found to be 0.74 %. However, only about one third of the patients (31 out of 95, 32.6%) with major anomaly had significant coronary atherosclerotic lesions among whom nine were found to involve the LCX artery with a posterior course.Conclusion: The incidence of congenital coronary anomalies in a selected population of the European part of Turkey is similar to those of other populations. Congenital coronary anomalies generally present as isolated anomalies and are not associated with an increased risk of coronary atherosclerosis in this series. Cardiologists and surgeons should be familiar with these entities for the proper management of patients undergoing cardiac surgery or coronary angioplasty.

Background: Thromboembolic disease (TED) represents one of the main reasons of morbitity and mortality in Western World. Venous and arterial thrombotic disorders have long been viewed as separate pathophysiological entities. However, in recent times the separate nature of arterial and venous thrombotic events has been challenged. Although inherited thrombophilia's predominant clinical manifestation is venous thrombosis, its contribution to arterial thrombosis remains controversial. Purpose of the study was to evaluate the prevalence of the most common thrombophilic mutations, FV Leiden G1691A-FVL and FII G20210A-PTM and to assess the differences between venous, arterial and mixed thrombotic events. Testing for polymorphism MTHFR C677T and antithrombin, protein C and protein S was also performed. Correlations with dyslipidemia, smoking, obesity, homocysteine and antiphospholipid antibodies were made.Methods: 515 patients with unprovoked TED, 263 males, median age 44 years, were studied. Patients were divided into three groups: 258 with venous thrombosis (group A), 239 with arterial (group B) and 18 with mixed episodes (group C). All patients were interviewed regarding family history of TED, origin, smoking and dyslipidemia. Body mass index (BMI) had been calculated. Molecular assessment of the FVL, PTM and MTHFR C677T was performed. Antithrombin, protein C, protein S, APCR, homocysteine, antiphospholipid antibodies and lipid profile were also measured.Results: The population studied was homogenous among three groups as regards age (p=0.943), lipid profile (p=0.271), BMI (p=0.506), homocysteine (p=0.177), antiphospholipid antibodies (p=0.576), and positive family history (p=0.099). There was no difference in the prevalence of FVL between venous and arterial disease (p=0.440). Significant correlation of PTM with venous TED was found (p=0.001). The number of positive and negative for MTHFR presented statistically significant difference with a support in arterial disease (p=0.05). Moreover, a 2-fold increase in the risk of venous thrombosis in FVL positive patients (odds ratio: 2.153) and a positive correlation of homocysteine levels with MTHFR C677T (p<0.001) was found.Conclusions: Correlation of PTM with venous thrombosis was established. Analysis showed no difference in prevalence of FVL between venous and arterial thrombosis, indicating that FVL might be a predisposing factor for arterial disease. A significant increase in MTHFR C677T prevalence in arterial disease was found. In conclusion, young patients with unprovoked arterial disease should undergo evaluation for thrombophilic genes. Identification of these mutations is important in the overall assessment and management of patients at high risk. Findings will influence the decisions of stratified approaches for antithrombotic therapy either primary or secondary thromboprophylaxis, the duration of therapy, the potential for avoiding clinical thrombosis by risk factor modification and the genetic counselling of family members. However, further studies are needed to clarify the nature of the association regarding venous and arterial thrombotic events.

Background and Aims: To measure the prevalence of overweight and obesity in adults in the Republic of Cyprus, and to evaluate and relate possible obesity risk factors of the adult Cypriot population.Methods: This is an epidemiological cross-sectional study on a stratified random sample of 1001 (48.5% males-51.5% females) subjects, aged 18-80 years old. Anthropometric, biochemical, and dietary/lifestyle characteristics included in the study.Results: The prevalence of overweight (Ow) and obesity (Ob) was 46.9% and 28.8% for males and 26% and 27% for females, respectively. Overweight and obese subjects were found to have statistically significant higher levels of Body Mass Index (p<0.001), Waist circumference (p<0.001), Total serum cholesterol (p<0.001), Low density lipoprotein (p<0.005), Glucose (p<0.007) and Triglycerides (p<0.001) compared to normal peers. In addition, Ow and Ob participants consumed significantly lower levels of fruits and vegetables (p<0.001), exercised less time/d (p<0.001) and smoke more cigarettes/d (p<0.001), compared to normal subjects, respectively. In multiple regression analysis of factors associated with overweight and obesity, Waist Circumference (beta: 1.132, p<0.001), Glucose (beta: 0.892, p<0.045), alcohol consumption (beta: 0.563, p<0.001), and exercise levels (beta: -0.444, p<0.001), were the most significant ones.Conclusion: The prevalence of overweight and obesity is very high in Cypriot adults. The current study also revealed a significant positive relation of Ow and Ob with waist circumference, high blood glucose levels and increased consumption of alcohol and a negative one with decreased levels of exercise.

Background. Demand and costs of laboratory testing are increasing worldwide. It seems that a considerable proportion of the tests requested do not follow the published guidelines. Tests comprising the lipid profile are advised for the entire population, as determinants of cardiovascular risk. Published guidelines exist for different groups of the population. This study is an attempt to assess the volume and the cost of the excessive demand for laboratory measurements of lipids concerning inpatients of a tertiary teaching hospital in Athens, Greece.Methods. Tests were characterized as inappropriate through revision of guidelines for lipid measurement. The demand for laboratory measurement of lipid blood levels was studied by collecting data from the hospital's test result database. The study was conducted during the trimester October to December 2008 and 20,698 tests from 3,279 inpatients were reviewed.Results. The results of this study are consistent with international observations showing a significant percentage of clinically inappropriate laboratory tests and the consequent financial burden. The inappropriately repeated lipid tests during the trimester reached the number of 7,938 costing € 12,680 to the hospital. Almost half of the inpatients were tested more than twice a month.Conclusions. Physicians' behavior is an important factor, as is derived by certain profiles of the wards studied. Guidelines are not followed when ordering lipid tests. Curtailing of these excessive laboratory tests has been shown to be feasible using cheap strategies and will yield considerable benefits for patients and hospitals alike.

Schwannomas are generally benign, slow growing tumors, which can originate from any nerve that has a Schwann cell sheath. Digestive tract schwannomas are rare and are usually asymptomatic. We present the case of a 48-year-old woman with a symptomatic submucosal tumour of the gastric antrum. The patient underwent partial gastrectomy and the histological and immunohistochemical findings of the resected specimen established the diagnosis of schwannoma.

Peritonitis is still the main complication of peritoneal dialysis (PD) in children. Staphylococcus, especially Staphylococcus epidermidis and Staphylococcus aureus, are the predominant species isolated, followed by Streptococcus spp. and by far by gram-negative bacteria and fungi. We describe three cases of PD-related peritonitis in pediatric patients due to uncommon gram-positive pathogens, which were treated with intraperitoneal antibiotic agents.

Background: In literature there are only a few descriptions of the typical presentation of solitary fibrous tumours (SFT) and only a few case reports showing its unusual clinical and radiological features.Methods: We retrospectively evaluated the computed tomography scans of 36 patients presenting with a histological diagnosis of SFT between 1998 and 2008.Results: We present five cases of SFT with an atypical clinical presentation and radiological features.Conclusions: SFT can occasionally present with unusual radiological features making a differential diagnosis difficult. Even thought imaging plays a fundamental role in the initial diagnostic approach, final diagnosis in only confirmed by biopsy and histology.

Traumatic brain injury sometimes can lead to psychotic disorder which resembles schizophrenia. We report a 17-yearold boy, admitted to psychiatric department for psychotic symptomatology. He had suffered penetrating craniocerebral injury after stabbing by a billiard stick, three years earlier. On admission, he expressed delusions with paranoid and religious content. The magnetic resonance imaging of the brain showed a 10 cm large tubular area of posttraumatic encephalomalacia of the left hemisphere, whereas the electroencephalography revealed slow left temporal activity. The patient's recovery was uneventful with clozapine at a dosage of 100 mg daily. This case shows the diagnostic challenge in differentiation between schizophrenia and psychotic disorder due to traumatic brain injury. The authors emphasise the importance of imaging of the brain, especially magnetic resonance, in establishing the diagnosis of psychotic disorder due to traumatic brain injury.

Lipomas of the colon are relatively rare benign tumors of mesenchymatic origin. They are usually asymptomatic but as they become larger they can cause symptoms including abdominal pain, diarrhea, nausea, constipation, haematochezia, loss of body weight, anemia or even intussusception and colonic obstruction. We present a 52 year old male patient who visited the emergency room complaining of constipation, rectal bleeding, mucus in stools and a palpable rectal mass. Colonoscopy revealed a polypoid mass of the sigmoid colon lying about 30 cm from the anal verge. Sigmoidectomy was performed. The postoperative recovery was uneventful and he was discharged five days later. At follow up a month after surgery the patient was asymptomatic. The pathological examination revealed a transmural tumor of the sigmoid colon measuring a 9x5x2.5cm and histologically compatible with a lipoma.

Idiopathic acute transverse myelitis is a focal inflammatory disorder of the spinal cord of unknown etiology diagnosed according to established criteria. As it occurs rarely in children herein we report a case of a 4 year old boy who developed clinical and radiological manifestations of myelitis, 10 days after a recent respiratory tract infection. Diagnostic workup failed to reveal a causative factor. After the administration of corticosteroids a clinical deterioration was observed and intravenous immunoglobulin was administered. Symptoms resolved within a 48-hour period, suggesting an immunemediated pathogenetic mechanism.